Ontario home care advocates silenced

Government-appointed boards will replace elected advocates - despite an
independent report that pointed to a lack of resources, not management, as a key
problem

Straight Goods --  Dateline: Sunday, December 30, 2001

By Dr. Gordon Guyatt

The provincial Conservative government is about to punish the agencies
responsible for delivering home care to Ontario citizens for doing their job.
The punishment will silence one of the few voices speaking effectively for a
vulnerable and under represented group, the frail elderly.

In June of this year, the publicly elected boards of the 43 Ontario Community
Care Access Centers (CACCs) courageously banded together with a message to the
provincial government. Unless the Tories could produce funding increases, major
cuts in home care were inevitable.

The public release of this message drew prominent media attention. The
announcement helped generate a flurry of public concern, including a series of
articles on home care in the Hamilton Spectator.

The Spectator series documented the problems with inadequate home care. The
articles echoed the warnings from the CCAC boards: unless the government
allocated more dollars to address CCAC deficits, the situation would only get
worse.

The overall result was negative publicity for the Tories, and increased public
concern about their neglect of our public health care system.

Since that time, the CCAC boards' dire predictions have come true. The
government refused to allocate additional funds, and severe cuts followed.
Examples include the Halton region, which has reduced homemaking services by
13,000 hours per month, nursing visits by 4,000 visits per month and
rehabilitation services visits by 4,000 visits per month. In Kingston, for a
four-week period, the CCAC had to refuse referrals for patients leaving
hospital.

The cuts have increased burdens on families, and community agencies. In
Hamilton, the waiting list for the Alzheimer Society's volunteer program to aid
family members providing care to their relatives suffering from dementia has
doubled.

This still left the government with the problem that the CCAC boards might cause
them further trouble. To understand the reason, we need to know why the boards
spoke out in the first place.

Currently, any member of the community can join a CCAC, and CCAC members elect
the volunteer board. The result is that most board members are people with a
special interest in the care of the disabled and elderly living at home, often
health professionals who have spent their career caring for these individuals.

The board members have no affiliation with the government. Their responsibility
is to the CCAC members who have elected them, and their allegiance is to the
population they serve. It is this allegiance that motivated them to speak out.
They believed the public had a right to know about how government policies
effect their vulnerable population. In what now looks like a dry run for their
punitive tactics, the Tory government wiped out Hamilton's board last summer
after they organized a public meeting to discuss problems caused by
under-funding. Whether or not there were important problems with the board's
management remains unclear. Either way, the government's recent behaviour
suggests that the public criticism contributed to the government's drastic
solution of replacing the board with their own "supervisor".

Now, the Tories have acted to silence the voice of all the elected CCAC boards.
Bill 130, introduced at the beginning of November, specifies that the government
will appoint the CCAC boards. That means that the Tories will choose board
members, often with Conservative party backgrounds, who will not embarrass them.

Given the dangers of critical comment, why did the government risk elected
community boards in the first place? Their general strategy is to put the
responsibility for implementing their cuts on an arms-length body, and hope that
the public will direct their fire at that body. In the case of school closing
decisions by the elected Board of Education, the strategy has worked quite well.
This time, due to the CCAC boards' effectiveness in working together, the
strategy backfired.

Could the government still be right about the need for a change in the selection
process for CCAC board members? In the press release announcing the new CCAC
legislation, the government refers to a province-wide independent
PriceWaterhouseCoopers report submitted in December 2000. The report evaluates
the accomplishments, and limitations, of the CCACs since the government
implemented the CCAC approach to home care management in 1997.

The report noted that, under the elected community boards, the CCACs had
"accomplished a lot in three years" and had "been working with each other, with
the Ministry, and with other stakeholders to continually improve the way they do
business."

Rather than limitations of the elected community boards, the problems the report
noted included the need for more home care resources, and inadequate payment for
staff, including visiting nurses, who receive far less than hospital workers. In
its 165 pages, the report did not include even a hint that the community board
selection process was seriously flawed, and that the government should consider
switching to an appointed board.

The new legislation is clearly about control, a political payback, and avoiding
public criticism, and not about accountability. As usual, I have to give the
government credit for great efficiency in implementing their political strategy.
They drafted their legislation in a very short period of time. Their vengeance
on the CCAC boards is swift, and sure.

Unfortunately, the government's behaviour is also profoundly cynical. Worst of
all, it robs a vulnerable and relatively powerless population, the disabled and
frail elderly struggling to continue to live at home, of a dedicated and
effective advocate. It's a high price to pay for the Tories' political agenda.

Gordon Guyatt, MD, FRCPC, is an academic physician at McMaster University in
Hamilton, Ontario.

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